Intrapartum-Related Stillbirths and Neonatal Deaths in Rural Bangladesh: A Prospective, Community-Based Cohort Study

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Abstract

OBJECTIVE: Using a low-cost community surveillance system, we aimed to estimate intrapartum stillbirth and intrapartum-related neonatal death rates for a low-income community setting. PATIENTS AND METHODS: From 2005 to 2008, information on all deliveries in 18 unions of 3 districts of Bangladesh was ascertained by using traditional birth attendants as key informants. Outcomes were measured using a structured interview with families 6 weeks after delivery. RESULTS: We ascertained information on 31 967 deliveries, of which 26 173 (82%) occurred at home. For home deliveries, the mean cluster-adjusted stillbirth rate was 26 (95% confidence interval [CI[: 24–28) per 1000 births, and the perinatal mortality rate was 51 per 1000 births (95% CI: 47–55). The NMR was 33 per 1000 live births (95% CI: 30–37). There were 3186 (12.5%) home-born infants who did not breathe immediately. Of these, 53% underwent some form of resuscitation. Of 1435 infants who were in poor condition at 5 minutes (5% of all deliveries), 286 (20%) died; 35% of all causes of neonatal mortality. Of 201 fresh stillbirths, 40 (14%) of the infants had major congenital abnormalities. Our estimate of the intrapartum-related crude mortality rate among home-born infants is 17 in 1000 (95% CI: 16–19), 6 in 1000 stillborn and 11 in 1000 neonatal deaths after difficulties at birth. CONCLUSIONS: Difficulty initiating respiration among infants born at home in rural Bangladesh is common, and resuscitation is frequently attempted. Newborns who remain in poor condition at 5 minutes have a 20% mortality rate. Evaluation of resuscitation methods, early intervention trials including antibiotic regimes, and follow-up studies of survivors of community-based resuscitation are needed.
Translated title of the contributionIntrapartum-Related Stillbirths and Neonatal Deaths in Rural Bangladesh: A Prospective, Community-Based Cohort Study
Original languageEnglish
Pages (from-to)e1182 - e1190
JournalPediatrics
Volume127
DOIs
Publication statusPublished - 2012

Bibliographical note

Author of Publication Reviewed: Matthew Ellis, PhDa, Kishwar Azad, FCPSb, Biplob Banerjee, MBAb, Sanjit Kumer Shaha, MSSb, Audrey Prost, PhDc, Arati Roselyn Rego, MScb, Shampa Barua, MBBSb, Anthony Costello, FRCPc, Sarah Barnett, PhDc

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